Tag Archives: Outcome measurement

In a prior blog (Direct speaking about INdirect outcomes: HCAHPS as a measurement*), I argued that HCAHPS questions were indirect measures of outcomes. Indirect measures are weaker than direct measures because they are influenced by tons of variables that have nothing to do with the outcome of interest. But wait!! There’s more! HCAPS can sometimes be a DIRECT measure; it all depends on what you want to know.

(If you know this, then you are way ahead of many when it comes to measuring outcomes accurately!!)

KEY POINTS:

If your research question is what do patients remember about hospitalization then HCAHPS is a DIRECT measure of what patients remember.

However if your research question is what did hospital staff actually do then HCHAPS is an INDIRECT* measure of what staff did.

Example:HCAHPS question #16 is, “Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?” Whether the patient answers yes or no, the response tells us only how the patient remembers it.

Why is this important?

Because if you want to know whether or not RNs actually taughtinpatients about their medications, then for the most direct & accuratemeasure you will have to observe RNs .

However, if you want to know whether patients remember RNs teachingthem about discharge medications, then HCAHPS question #16 is one of the most direct & accurate measure of what they remember.

When you first plan a project, you need to know what OUTCOMES you want to achieve. You need STRONG outcomes to show your project worked!

Outcome measures are tricky & can be categorized into Indirect & Direct measures:

INDIRECT outcome measures are often affected by many factors, not just your innovation

DIRECT outcome measures are specific to what you are trying to accomplish.

For example: If you want to know your patient’s weight, you put them on the scale (direct).You don’t merely ask them how much they weigh (indirect).

Another example? If you planned music to reduce pain, you might a) measure how many patients were already using music and their pain scores (& perhaps those not using music and their pain scores), b) begin your music intervention, and c) then directly measure how many patients started using it after you started your intervention and their pain scores. These data DIRECTLY target your inpatient outcomesversus looking at INDIRECTHCAHPS answers of discharged patients’ feelings after the fact in response to “During this hospital stay, how often was your pain well controlled?”

Nurses often decide to measure their project outcomes ONLY with indirect HCAHPS scores. I hope you can see this is not as good as DIRECT measures.

So why use HCAHPS at all?

They reflect institutional priorities related to quality and reimbursement

Data are already collected for you

Data are available for BEFORE and AFTER comparisons of your project outcomes

It doesn’t cost you any additional time or money to get the data

Disadvantages of indirect HCAHPS measures?

HCAHPS data are indirect measures that are affected by lots of different things, and so they may have little to do with effect of your project.

HCAHPS responders often do Not represent all patients because the number responding is so small–sometimes just 1 or 2

Still, I think it’s good to include HCAHPS. Just don’t limit yourself to that.Include also a DIRECT measure of outcomes that targets the precisely what you hope will be the result of your study.

You need STRONG outcomes to convince others that your project works to improve care!

FOR MORE INFORMATION: Whole books of measurement instruments are available through the library or a librarian can help you search for something that will measure motivation, pain, anxiety, medication compliance, or whatever it is you are looking for!! You can limit your own literature searches by selecting “instrument” as part of your search, or you can consult with a nurse researcher for more help.